SBM Little Application

| Resume a previously saved form
Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Hidden Fields

REQUIRED: This form MUST be signed (e-signature) by the parent or legal guardian of the child being enrolled.

PLEASE NOTE: If this form is being completed with the assistance of another individual (not the parent or legal guardian) it is critical that the parent or legal guardian be present during it's completion to review all information provided and to review all conditions of consent included within this application.

Please answer the following questions:

Transportation Information

Please list below any adult you give consent to pick up your child. Individual must bring photo ID when they pick up your child.

Emergency Information

Person(s) to be contacted in emergency situations if parent/guardian is not reachable: 

School-Based Mentoring Parental Consent

By checking the box below, I give permission for my child (identity provided on the previous page), to participate in the Big Brothers Big Sisters of Mid-Maine (BBBSMM) School-Based Mentoring one day per week after school. In doing so I understand and agree to the following:
  • My child (Little) will meet with their (Big) one day per week, throughout the school year.
  • Bigs and Littles will be expected to participate in a Summer Pen Pal program in the summer months (i.e. post cards, letters, and/or emails).
  • The school guidance counselor may share information regarding my child with BBBSMM for the purpose of determining a suitable mentor and addressing child safety concerns as well as reporting on school attendance and overall performance.
  • For the school to provide social, academic, demographic and contact information about my child to Big Brothers Big Sisters (e.g. report cards, behavior reports, parent contact information etc); 
  • All applicant information in regards to my child, including home address, will be kept confidential. 
  • I am responsible for picking-up my child, or arranging transportation for my child, at the designated end time of match meeting.
  • BBBSMM does not guarantee my child will be matched and has discretion in creating and/or closing or a match in regards to child safety and the best interests of all parties involved.
  • I understand contact outside of school mentoring activities is not permitted.

Media Release

Big Brothers Big Sisters of Mid-Maine creates media (brochures, press releases, annual appeal letters, BBBSMM website, social media, tv, radio spots, etc.) to highlight match successes and recruit volunteers. I understand my child's interaction with his/her match may be photographed/taped and possibly used for these agency purposes only.

Emergency Medical Consent

I, the parent/guardian of the child/youth for whom this application is being completed, consent to the performance of such emergency medical care upon my son/daughter, for whom this application is being completed, as may be deemed necessary or advisable in the judgment of the examining physician in the event I cannot be reached at the time of said emergency.


I consent to my child's use of TheApp, an online communication tool to help matches stay connected when they are not able to meet in person or to supplement in-person visits. TheApp is part of Big Brothers Big Sisters online data organization system; and all communication between Bigs and Littles is monitored by Agency Staff.
Supporting Information